The erroneous application of code-based reimbursement methods creates underpayments.
We provide sophisticated payment verification services to ensure our clients receive accurate reimbursements according to the contractual agreements with their payers. Whether an underpayment is due to miscalculation or inappropriate denial, we will identify and recover this missed reimbursement.
Better than the Competition
We capture all payment/adjustment transactions and through our proprietary process properly configure the data to determine how the payer has adjudicated the claim. This allows us to find underpayments where other firms cannot.
In addition to the recovery of cash, the process provides information on payer actions that can be used in future contract negotiations.
We also work with the Business Office and Medical Records to correct any related deficiencies in your current process.
Move Beyond Manual Denials Management
As an industry, about 10% of your claims will be denied on average. Today's generally accepted processes for reworking denied claims are outdated and too costly.
- Our Denial Management system is tailored according to your current process by customizing the system to recognize true denials according to your definition.
- That same data is merged into appeal letter templates using industry standard word processing formatting.
- We then assign denials to your team according to the workflow you've defined.
- Our reporting package allows you to quickly and efficiently identity problem areas and quantify improvements.